Post-traumatic stress disorder (PTSD) and depression are common conditions that can occur after critical illness. These disorders have been described among survivors of critical illness as well as family members of survivors of critical illness. Both conditions have significant burdens associated with them, with inability to work or return to prior levels of functioning, as well as reduced quality of life and increased cost to society due to increased health care costs. Family members are an important group to consider because the experience of care in the intensive care unit extends beyond critically ill patients to the family members of those who are critically ill. The goal of this proposal is to identify associations between specific processes of ICU care and long-term psychological outcomes including PTSD and depression among survivors of acute lung injury and their family members. We hypothesize that there will be significant correlation between psychiatric symptoms of patients and similar symptoms of their family members and that this correlation will provide insights for interventions targeting patients and their families. Data will be collected as a longitudinal cohort study at Harborview Medical Center, a large county hospital in Seattle, Washington. Patients and their family members will be surveyed at 3 and 6 months following discharge from the ICU. Multivariate analysis will be used to examine associations between patient specific processes of care and patient long-term psychological and quality of life outcomes. Additional multivariate analysis will be used to examine associations between family specific processes of care and family long-term psychological and quality of life outcomes. Finally, we will look for correlation between these outcomes in patients and their family members to provide insights for future interventions. Acute lung injury is common in the ICU, and long-term psychological outcomes appear to be common among survivors of this critical illness. Family members also have long-term psychological consequences of their loved one's critical illness. It is important to identify specific processes of care associated with these psychological outcomes in order to develop focused interventions to decrease this morbidity.